Health Indicator Report of Cervical Cancer Screening (Pap)

Why Is This Important?

Cervical cancer is one of the most curable cancers if detected early through routine screening.
Almost all cases of cervical cancer are caused by infection with high-risk types of the human papillomavirus (HPV). The HPV vaccine protects against the HPV types that most often cause cervical cancer. Women who have had an HPV vaccine still need to have routine Pap smears because the vaccine does not fully protect against all the strains of the virus and other risk factors that can cause cervical cancer.
HPV is transmitted through sexual contact. Any woman who is sexually active is at risk for developing cervical cancer. Other risk factors include giving birth to many children, having sexual relations at an early age, having multiple sex partners or partners with many other partners, cigarette smoking, and use of oral contraceptives.
The U.S. Preventive Services Task Force recommends cervical cancer screening (Pap smear) every 3 years for women 21 to 65 years old. For women 30 to 65 years old, Pap smears may be conducted every 5 years in conjunction with human papillomavirus (HPV) testing.

Chart

Data Table

Pap Smear in the Past Three Years by Race, Utah, 2014

Data Notes

Notes

Age-adjusted to the U.S. 2000 standard population based on 3 age groups: 18-34, 35-49, and 50+.

Data Source

Data Interpretation Issues

To reduce bias and more accurately represent population data, the BRFSS has changed survey methodology. In 2010, it began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method. More details about these changes can be found at: [http://health.utah.gov/opha/publications/brfss/Raking/Raking%20impact%202011.pdf].

Health Indicator Definition

Definition

The proportion of women 18 years or older who reported having a Pap test in the last three years.

Numerator

The proportion of women 18 years or older who reported having a Pap test in the last three years.

Denominator

The total number of female survey respondents aged 18 or older excluding those who responded "don't know" or "refused" to the numerator question.

Health Objectives and Targets

Healthy People Objective C-15:

Increase the proportion of women who receive a cervical cancer screening based on the most recent guidelinesU.S. Target: 93.0 percentState Target: currently being revised

Current Outlook

How Are We Doing?

Between 1991 and 2010, the percentage of Utah women aged 18 or older who reported receiving a Pap test within the last three years decreased from 88.2 percent to 74.0 percent (old methodology, age-adjusted rates).
To reduce bias and more accurately represent population data, the Behavioral Risk Factor Surveillance Survey (BRFSS) has changed survey methodology in 2010. It began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method. Based on this methodology, Utah's 2014 rate was 69.5 percent (age-adjusted rate). All additional indicator views are based on the new methodology.
For combined years 2012 and 2014, Utah County, TriCounty, and San Juan local health districts reported significantly lower cervical cancer screening rates (65.3 percent, 62.0 percent, and 51.2 percent respectively) when compared to the state (69.8 percent). After dividing the health districts into Utah Small Areas, the prevalence of Pap tests for combined years 2012 and 2014 ranged from a high of 84.4 percent in Woods Cross/North Salt Lake to a low of 56.2 percent in Provo (North)/BYU.
There were no significant differences in cervical cancer screening rates in 2014 among Hispanic and non-Hispanic ethnic groups.
In 2014, and when looking at the highest level of education completed for women 25+, college graduates were significantly more likely to have received a Pap test than those that did receive a college degree (college graduate, 77.0 percent; some post high school, 74.1 percent; high school graduate, 67.8 percent; below high school, 67.5 percent).
Also in 2014, women in households with lower annual incomes were significantly less likely to have had a Pap test within the past 3 years (58.6 percent for incomes less than $25,000; 69.9 percent for incomes of $25,000-$49,999; 71.6 percent for incomes of $50,000-$74,999; and 76.3 percent for annual incomes of $75,000 or more).
For women of screening age in 2014, younger women ages 18-34 reported significantly lower rates (66.2 percent) when compared to older women (ages 35-49, 80.4 percent; ages 50-64, 76.5 percent).

How Do We Compare With the U.S.?

Nationally, the percentage of women aged 18 or older who reported receiving a Pap test in the past three years decreased from 88.6 percent in 1989 to 80.6 percent in 2010. Since then, and with the new BRFSS methods, national Pap test screening rates have continued to decline (83.0 percent in 2010 and 74.9 percent in 2014).
Utah screening rates are also on a downward trend and have consistently been lower than national rates in the past decade. Using the new BRFSS methodology, 69.5 percent of Utah women aged 18 or older reported receiving a Pap test in 2014.

Health Improvement

What Is Being Done?

The Utah Cancer Control Program (UCCP) provides free to low cost Pap tests and pelvic exams to women who meet age and income guidelines. Eligible women with abnormal screening exams are offered diagnostic evaluation by participating providers. In addition, the UCCP provides education about the need for early detection and the availability of screening services, collects outcome data, and disseminates information about cervical cancer.
The Utah Department of Health also initiated the Utah Cancer Action Network (UCAN), a statewide partnership whose goal is to reduce the burden of cancer. The mission of the UCAN is to lower cancer incidence and mortality in Utah through collaborative efforts directed toward cancer prevention and control. As a result of this planning process, objectives and strategies have been developed by community partners regarding the early detection of cervical, testicular, prostate, skin, breast, and colorectal cancers as well as the promotion of physical activity, healthy eating habits, and smoking cessation.

Available Services

The Utah Cancer Control Program (UCCP) provides free and low cost Pap tests and pelvic exams to women who meet age and income guidelines. Eligible women with abnormal screening exams are offered diagnostic evaluation by participating providers. As of July 1, 2001, the UCCP is able to refer Utah women in need of treatment for cervical cancers and precancerous lesions to Medicaid for full benefits. The women must meet all requirements as outlined in the National Breast and Cervical Cancer Treatment Act.
In addition, the Utah Immunization Vaccines for Children (VFC) program provides low cost HPV vaccines to females ages 9 to 18 who meet income guidelines.

Health Program Information

In 1976, the Utah Department of Health received a cervical cancer grant from the National Cancer Institute. In 1980, the Utah Department of Health began providing clinical breast exams and Pap tests on a sliding fee scale. In 1993, state funding was appropriated for mammography. In that same year, the Utah Cancer Control Program (UCCP) first received a capacity building grant from the Centers for Disease Control and Prevention to conduct breast and cervical cancer screening in Utah. A comprehensive grant was awarded to the program in 1994 to continue breast and cervical cancer screening. Since 1994, the UCCP and partners, including local health departments, mammography facilities, pathology laboratories, and private providers, have worked together to ensure the appropriate and timely provision of clinical services.
The UCCP continues to receive funding from the CDC for breast and cervical cancer screening. Additionally, the UCCP receives funding to implement comprehensive cancer control strategies that were identified by the Utah Cancer Action Network (UCAN) statewide partnership.

Utah DOH

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